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  • Mitch Ware

Episode 5: Non-Profit vs. For Profit

Updated: Mar 31, 2020

In this episode, Mitch discuses difference between Non-Profit and For Profit Hospice organizations.

"What differentiates the good from the less than good is not being for profit or nonprofit. It's the culture that your hospice has developed that matters."


Welcome to another episode of Living With Hospice. My name is Mitch Ware I'll be your host today. I've been involved with Hospice for over 13 years, both as a family caregiver and he trained hospice volunteer. I just made a fresh pot of coffee in anticipation of your visit. So grab a cup and pull up a chair. Let's talk today about non profit versus for profit hospice. And why should I care? Or should I even care? As I mentioned in previous episodes, I am Hospice volunteer. Been doing that for quite a while. I'm not a doctor. I'm not a nurse. I'm not a social worker or a therapist. I'm not a chaplain. I'm not Ah, uh, accountant. However, I do have a lot of literally hands on experience with several hospice organizations. And I just want to share some of that information with you through Aah! These podcasts and I look forward to hearing from you at the end of this podcast will give you an email address that you consent your questions directly to us and we will get to those and who knows might answer your question right here on a podcast by the way The whole gang is here today. Cosmo Kramer are big dog who is half Alaskan, husky and half Irish. Wolfhound or so we're told. Charlie, Mr Mayor, the boss cat, he's running around here. Chloe just ran through and she's jumped up on top of the cat condo. And we have a visitor today. Mia, who is my son's dog? She's just a pup, and we're dog sitting for my son for a few more days were up here in the cold, and he's down in the Caribbean and we're dog sitting. Okay, so, uh, in our previous episode, we mentioned that there are non profit organizations and for profit hospice organizations in this episode, let's take a look at the difference between the two so you can make amore informed decision when you choose a hospice, as recently is, uh, well, let's see. 35 40 years ago, most hospice providers were pretty much non profit and operated as charitable concerns. Roughly two out of every three hospice are operated as for profit, often by large national chains. Nowadays there's a rapid expansion as you may or may not know of hospice, which I think is really a function of ever evolving cultural attitudes about our end of life journey. A lot of people don't want to think about end of life journeys, but when they do, people are beginning to explore options, I may add. It's a good change in our cultural attitude about living and dying with dignity. Nobody should have to die alone. Nobody, nobody should have to die in pain. Nobody in America today, thanks to the thousands of hospice organizations literally last, I saw over 4000 hospice organizations in the U. S. Alone. Everyone should be able to have a pain free, comfortable end of life experience. More and more people that are in the winter of their lives are increasingly opting for palliative care. That means addressing their comfort in physical and emotional and spiritual needs, and it's important to do that is setting of their choosing, a setting that they're comfortable in. Typically, that's in their own home. Sometimes it's in an assisted living facility or in a inpatient care facility. People would rather do that by and large over painful treatments that they continue on that may or may not prolong their life and make their end of life experience not very pleasant. According to the statistic dot com statistics, more than 1.4 million people in the U. S are in the care of hospice in 2017. That's the most recent data. And of course, that number continues to grow. According to a report from the CDC, there are 454,500 hospice organizations in the United States alone, and 63% of those are for profit. Now, Before we get into the nitty gritty of the differences between the two, let me say that there are good hospice organizations and there are some less than good hospice organizations, and it doesn't make any difference if their for profit or nonprofit just like anything else in life. What differentiates the good from the less than good is not being for profit or nonprofit. It's the culture that your hospice has developed that matters. For example, hospices air paid per diem. For each patient, that means that they receive money, usually somewhere around this is an average of averages about $150 a day per patient for Medicare or private insurance. That is every day, seven days a week, every week of the year that they are in hospice care. There are some less than good hospices that only provide full service is say, well, Monday through Saturday or Monday through Friday. Yeah, that's right. You heard right. There are some out there that are less than scrupulous, and they they get disciplined. They get their hands slapped, maybe even find some, even get sued. But like any large group of organizations, you confined some bad apples and for profit and nonprofit. So the rial ki again is to look at the hospice you're considering culture. Look at the service is they provide look at their track record, go online and look the reviews that have been left. And that's our next episode's topic. But back to our question for this episode. What separates the for profit from the nonprofit hospice? Short answer is this. As far as you and I are concerned, not much, really. Not much one is not intrinsically better than the other a ce faras, really? You know, you and I, as users are concerned. Okay, so that's the big difference that, um I guess really means anything's tow us is that nonprofit hospices are not required to pay taxes to the state or federal governments on the funds that they receive, like from Medicare and the insurance companies and private pay and so forth. Tax exemption is a standard for all non profit organizations and is not exclusive to hospice. For example, your church is probably a nonprofit, and they don't pay taxes either. Ah, maybe you have a 501 c three organization that you that you donate to and they wouldn't pay federal and state taxes, either. They're a nonprofit now the rub. Here is that the nonprofit hospice cannot show any profit on the books at the end of their fiscal year. And rest assured, Medicare and state governments are always looking for compliance issues. If you work in a business or you own a business and you were 100 Holy mackerel. How in the world is that work? How can you stay in business and actually show no profit? Well, to be clear, nonprofit hospices do make money over the course of the year. They have to cover their expenses, but they have very limited amount of money on the books at the end of the year, in order to qualify and keep their nonprofit status. So where does all that money go? That's left over, assuming that there is money left over. Frankly, that's up to the individual hospice organization and how they choose to allocate it. Typically, that money goes into community affairs or around here. A lot of times, that money goes into scholarships that cover patients, expenses that don't have money or they don't have insurance again. All of this allocation of money is extremely closely scrutinized by the state and federal governments. You know, interesting enough. Many for profit hospices have a nonprofit foundation set up. That's a separate division that falls underneath the 501 c three i. R. S code. These organizations were set up toe collect like in kind donations and also known as ah, memorial donations and in many for profit hospices, use thes contributions for patients who have special needs, such as helping in maybe pain there Ah, there heat bill in the winter or a small household repairs, maybe some special equipment. And sometimes I've even heard about travel arrangements for out of town family members so that who otherwise couldn't come to visit their loved one. But this Foundation will will fund that that particular trip and sometimes even lodging. So again, what's the difference between for profit and nonprofit hospices as it relates to you and me? Or we can get into all the nitty gritty of the finances. But that really doesn't impact you. And I, in the short answer, is the differences. Well, really, not much Now, let me be clear. I'm a fan of both. I currently work with a nonprofit hospice, but I have experience with for profit hospices. Well, each of these hospice organizations a really unique unto themselves, regardless of whether it's for profit or not for profit. Each has its own culture, its own way of doing things. That is what the patient and the patient's families need to look at. Service is rendered and quality of care that all kind of distills down to that particular hospice organizations culture. Take a look. The staff. Are they happy to be there? Do they enjoy their work? Are they great with people? In the late 19 eighties, the for profit or hospice organizations began to grab market share. They marketed themselves directly to doctors and medical organization, stating that they could provide for their patients faster and basically better service to make those lives easier. As a result, the nonprofit hospice census went down. The for profit hospice senses began to grow. These for profit hospices approached their marketing like any business would, with ads on the TV and radio and ads in the newspapers mirror. This is the eighties when we still most of us, still got a newspaper. And of course, nowadays that's translated over into social media. The for profit basically forced the nonprofits to be more competitive, and we see that today, in service is and quality of care provided. It's an example of just competition forcing the marketplace or those in the marketplace to do a better job. The Center for Medicare Medicaid, which is a federal agency, has ruled that all hospices, all hospices, should be focused on providing patient centered care, not payment centered care. You say that again. All hospices are to be focused on providing patient centered care, not payment centered care. There are those rumors going around that you no one's better than the other. That's not true. Relative toe for profit or nonprofit. They're excellent organizations in both, and I've seen them. It really boils down again to unique culture. And what is the best culture or the best fit for you in your family situation? I found this rather interesting when I was doing some research while back, um, some reports that came across show most patients in the for profit hospice are covered by Medicare, private insurance or private pay. They also are more apt to well have a longer term stay. And I can only assume that these patients have been diagnosed early and they have had excellent medical care because they do have insurance. And they've decided to transition over to palliative care when curative care no longer is a viable option. And for some reason they decided to go with a for profit hospice organization. And in some cases in the locality that they're living there may only be a for profit hospice organization there. When you really look at the differences between profit and nonprofit hospice organizations, I believe you'll see they really aren't so different. As far as you and I are concerned, I keep saying that because it's true hospices, regardless of how they're organized, be it profit or nonprofit, they're on the same mission. They're here to help people in the end of life, and two live their lives full, enriched with dignity and in comfort. They want to help the patient as well as the family in the caregivers and their physicians. So remember, all hospice organizations are to follow the same rules, and that's the rules of conditions of participation. They should all have wonderful staff members and are prone to giving back to their community Are there except singe. Sure, there's exceptions to everything in life, but most hospices, the huge majority of hospices are not good. They're just great. They're amazing. The difference that really stands out is one of a personal choice. When you're choosing the hospice, that is right for you and in your family, finding the organization that has the personal touches that appeal to you, maybe the motivating factor that you would want to consider. That is what we are going to discuss in our next episode. How do I pick the right hospice for me? How do I know what's going to be a good fit for our family and our family situation? So before we wrap this episode up and get on to the next episode. Let me leave you with a little story that might get you to thinking a little more about how important this decision is and how it should be made in a timely fashion. There was a family in our community whose grand parents were allowed to come here and received green cards. The grandfather worked in the fields outside of town here, and he, you know, planted crops and harvested crops and maintained the fields and in the barns and so forth. It's hard, backbreaking work, the heat of the summer. You know, nobody else interior really wanted to do that work thes. Particular crops just can't be planted by machines, and they can't be harvested by machines. The hours are long. The pay was fair, but not much more than enough for his wife and he to contribute to the family household. In the fall, this gentleman was diagnosed with stage for prostate cancer. It has spread to other organs. By the time they found it, he was in great a lot of pain. He made several trips to the E. R. And, well, they'd let him lay in a bed suffering while they figured out who was going to pay for his treatment. They did the best they could to keep him comfortable until they figured out how someone is going to pay for any advanced care. He later for hours and several medical workers came in, and all they said was, We're working on it, sir, Is there anything else we can do for you? In the meantime, they offered him Motrin and such, you know, But that wasn't really going to touch this man's pain. He was finally discharged. He had no insurance. He had a green card. But the red tape nightmare of even seen if he was eventually even partially covered by anything Medicare, Medicaid, private, whatever was just a fool's errand. He died the next day in his son's truck as they drove out to the fields. Is this unique? Yep. But not unique enough. This man's only hope for a better end of life experience was for someone to share with him or his family about hospice, but he fell through the cracks at every turn. General practitioner, someone anyone could have steered him to hospice, and a lot of this pain management and anxiety and all this hard work that he did up to the day he died may have been avoided, and his end of life journey would have been much more comfortable for years. This sort of thing has happened in jam packed hospitals. You've seen it. If you go to the E r, especially in major communities or large communities, you see the overcrowded conditions, same thing at clinics. You know, this is really a human rights issue that we all should care about. Nobody should have to die alone. Nobody should have to die in pain. But what about the millions of uninsured poor Americans who simply have no way to pay for the care? And they don't know where to turn? We need to get the word out. There is a solution. It's called Hospice Hospice. Although growing in popularity is still one of the best kept secrets in our society, we need to get the word out that there is a hospice care for everyone. In summary, we've covered a lot today non profit for profit, all of these air pretty much the same as it relates to you and I, the end user, if you will, a better question one should ask is What's the best hospice for me or my loved one? That is what we're going to explore in our next episode. Thank you for spending your time with me today. I'm very passionate about making sure everyone has a positive journey in their end of life experience. And, well, I want you to be informed. I want you to be equipped and armed with timely and accurate information in an effort. Help you make the best possible decisions that you can regarding hospice and end of life. As always. If you have any questions about hospice or hospice related situations, drop us a note. You can reach us at And who knows? We may cover your question in a future episode. So thank you for tuning in to the podcast until next time. I'm Mitch Ware with all the critters here that you might have heard during this broadcast wishing you a very blessed rest of your day

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